DSM-5 and Clinical Social Work: Mental Disorder and Psychological Justice as Goals of Clinical Intervention

Wakefield, Jerome C.

doi:10.1007/s10615-013-0446-1

Cited by 17 publications

(21 citation statements)

References 36 publications

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“…All OS/U categories should be reframed so that diagnosis requires clinical judgment that the symptoms are likely better explained by a psychological dysfunction than by a normalrange reaction, thus satisfying the DSM-5's definition of disorder. Other functions of evaluation, such as interventions to address unfairness of opportunity due to mismatches between individuals' normal psychological natures and social demands, a goal distinct from treatment of disorder that RDoC: Research Domain Criteria I have called "psychological justice" (Wakefield 2010(Wakefield , 2013b(Wakefield , 2015a, should be moved to the Z Codes.…”

Section: Subthreshold Diagnosis and The Missing Dysfunction In "Othermentioning

confidence: 99%

Diagnostic Issues and Controversies in DSM-5: Return of the False Positives Problem

Wakefield

2016

Annu. Rev. Clin. Psychol.

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The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was the most controversial in the manual's history. This review selectively surveys some of the most important changes in DSM-5, including structural/organizational changes, modifications of diagnostic criteria, and newly introduced categories. It analyzes why these changes led to such heated controversies, which included objections to the revision's process, its goals, and the content of altered criteria and new categories. The central focus is on disputes concerning the false positives problem of setting a valid boundary between disorder and normal variation. Finally, this review highlights key problems and issues that currently remain unresolved and need to be addressed in the future, including systematically identifying false positive weaknesses in criteria, distinguishing risk from disorder, including context in diagnostic criteria, clarifying how to handle fuzzy boundaries, and improving the guidelines for "other specified" diagnosis.

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Section: Subthreshold Diagnosis and The Missing Dysfunction In "Othermentioning

confidence: 99%

Diagnostic Issues and Controversies in DSM-5: Return of the False Positives Problem

Wakefield

2016

Annu. Rev. Clin. Psychol.

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“…Similarly, the claim that excluded cases have elevated suicide attempt rates was examined in four epidemiological data sets and disconfirmed (Wakefield & Schmitz, 2014a, c). Further epidemiological studies of both concurrent and predictive validity revealed that the negative outcomes characteristic of standard MDD, including recurrence, suicide attempt and anxiety disorders, occurred no more often in BE-excluded cases than in the general population with no history of MDD, unlike standard MDD which had high rates of these negative outcomes (Mojtabai, 2011;Gilman et al 2012;Wakefield & Schmitz, 2012, 2013b. The evidence spoke clearly, but DSM-5 refused to listen.…”

Section: Elimination Of the Major Depression Bereavement Exclusionmentioning

confidence: 99%

DSM-5, psychiatric epidemiology and the false positives problem

Wakefield

2015

Epidemiol Psychiatr Sci

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The revision effort leading to the publication of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was flawed in process, goals and outcome. The revision process suffered from lack of an adequate public record of the rationale for changes, thus shortchanging future scholarship. The goals, such as dimensionalising diagnosis, incorporating biomarkers and separating impairment from diagnosis, were ill-considered and mostly abandoned. However, DSM-5's greatest problem, and the target of the most vigorous and sustained criticism, was its failure to take seriously the false positives problem. By expanding diagnosis beyond plausible boundaries in ways inconsistent with DSM-5's own definition of disorder, DSM-5 threatened the validity of psychiatric research, including especially psychiatric epidemiology. I present four examples: increasing the symptom options while decreasing the diagnostic threshold for substance use disorder, elimination of the bereavement exclusion from major depression, allowing verbal arguments as evidence of intermittent explosive disorder and expanding attention-deficit/hyperactivity disorder to adults before addressing its manifest false positives problems.

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“…Namely, it has been suggested that the diagnostic labeling process is constantly shaped by cultural and policy environments, in which mental health services are provided under specific diagnostic criteria [ 42 ]. Studies indicate that social workers and physicians frequently face the dilemma of altering diagnoses due to procedural aspects of clinical care, such as the attainment of reimbursement [ 43 – 45 ]. Although warranting further research, our findings may suggest that this phenomenon occurs not only in the diagnosis of major depression [ 45 ] but also in the diagnosis of schizophrenia, as the probability of frequently assigning a schizophrenia diagnosis was associated with the view that an inaccurate diagnosis can result from such a process.…”

Section: Discussionmentioning

confidence: 99%

Attitudes of mental health clinicians toward perceived inaccuracy of a schizophrenia diagnosis in routine clinical practice

et al. 2018

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BackgroundMental health clinicians have previously been reported to express reservations regarding the utility and accuracy of the psychiatric classification systems. In this study we aimed to examine clinicians’ experiences with instances of perceived inaccuracy of a schizophrenia diagnosis.MethodsMental health clinicians (N = 175) participated in an online survey assessing prevalence and perceived reasons for inaccuracies of a schizophrenia diagnosis. Respondents included psychiatric ward directors (13.1%), senior psychiatrists and psychologists (40.5%), and psychiatry and clinical psychology residents (36%).ResultsFifty-three percent of respondents reported encountering instances where a schizophrenia diagnosis was assigned even though clinical presentation did not match diagnostic criteria. Seventy-three percent of senior psychiatrists in a position to determine a diagnosis declared assigning schizophrenia even when controversial among clinical staff, and 15% of them declared doing so frequently. The likelihood of frequently assigning a schizophrenia diagnosis even when clearly controversial was predicted by the perception that an inaccurate diagnosis is assigned due to the presence of negative symptoms (OR 2.20, 95% CI 1.04–4.66, p = 0.039) and due to patient-related factors, such as the need to facilitate rehabilitation (OR 1.77, 95% CI 1.07–2.90, p = 0.024).ConclusionsAlthough a schizophrenia diagnosis is considered relatively stable and clear, our study indicates that, in clinical practice, the assignment of this diagnosis is frequently controversial. These controversies are associated with the perception that an inaccurate diagnosis is assigned due to diagnostic considerations, or due to the possibility that patients might benefit from such a diagnosis. Implications and limitations for psychiatric practice and discourse are discussed.

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DSM-5 and Clinical Social Work: Mental Disorder and Psychological Justice as Goals of Clinical Intervention

Cited by 17 publications

References 36 publications

Diagnostic Issues and Controversies in DSM-5: Return of the False Positives Problem

Diagnostic Issues and Controversies in DSM-5: Return of the False Positives Problem

DSM-5, psychiatric epidemiology and the false positives problem

Attitudes of mental health clinicians toward perceived inaccuracy of a schizophrenia diagnosis in routine clinical practice

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